Tuesday, October 28, 2008

Round Three - One More Time

To paraphrase an insurance letter from Blue Cross Blue Shield I received today from another disgruntled patient:

Dear Doctor,

We regret that we cannot pay your claim despite the letter we requested and the copy of the chart you sent us before. Please send us the information one more time so we may reopen the file for consideration and have it reviewed by our medical reviewer.

Sincerely,

Blue Cross Blue Shield Delay Payment Squad

PS: We'd really appreciate you taking your time to comply with this letter as we earn more interest on the money your patient has already paid us - you're the best.

I can't tell you how many of these letters I'm getting now with the economic downturn. And the sad thing is, everyone knows it's happening but noone's doing anything about it.

Welcome to third party payment schemes 101.

Now, anyone want to talk about "never events" with the insurance industry?

-Wes

29 Oct 2008 10:45 AM CST Addendum: An example of one of many such letters.

One wonders, in this era of electronic medical records, if all the computer infrastructure and endless piles of documentation are worth anything in situations like this. But, alas, it's just another example of covert rationing.

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About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.